The Advantage of an Endoscopic Submucosal Tunneling Technique for Rectal Carcinoid Tumors

Endoscopic treatment can be a curative option for small carcinoid tumors with an extremely low risk of metastasis. Since most carcinoid tumors are characterized by a specific growth pattern in the submucosal (SM) layer, specialized endoscopic techniques for deeper resection to achieve clear vertical margins are needed. The endoscopic submucosal dissection (ESD) method in the SM space is superior to conventional endoscopic mucosal resection. However, the standard ESD technique sometimes fails to provide complete deep SM dissection due to insufficient SM lifting. Here, to resolve this problem, we describe our initial experience with an endoscopic SM tunneling technique that is effective for treating rectal carcinoid tumors.

Single-incision laparoscopic appendectomy for acute appendicitis using a 10-mm laparoscope and the glove port technique

Objective: To evaluate the single incision laparoscopic appendectomy [SILA] using existing instruments, the 10-mm laparoscope, and glove port technique

Methods: SILA was performed on 16 patients [8 male cases, 8 female cases] between June 2012 and September 2015. A 20-mm incision was made in the umbilicus and a wound retractor was placed. A 10-mm trocar for the laparoscope and two 5-mm trocars were fixed to the three fingers of the latex gloves and it was attached to the wound retractor. Another thin forceps were inserted from right low abdomen

Results: Average age of patients was 32.6 +/- 17.7 years. Preoperative average white blood cell was 13,325 +/- 4,584 /mm3, and average CRP was 1.81 +/- 3.70 mg/dL. Preoperative body temperature was 36.8 +/- 0.5°C. The mean appendix size was 9.6 +/- 2.3 mm and none of the patients had an abscess on preoperative CT. The CT also revealed a fecal pellet in 5/16 [31%] of patients. Mean operation time was 66.4 +/- 25.4 minutes, and minimal intraoperative bleeding was observed in all patients. Average hospital stay was 5.3 +/- 1.9 days and none of the patients had complications

Conclusion: SILA using the 10-mm laparoscope and glove port technique may be a safe and feasible operation for mild to moderate appendicitis

Colored Ring-Shaped Thread Tag Clippings to Identify the Accurate Location of Multiple Polyps Resected via Endoscopic Mucosal Resection

No abstract available.

Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract

Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.